Provider Demographics
NPI:1144810771
Name:ENRIQUEZ, MICHELLE S (LCSW)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:S
Last Name:ENRIQUEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2058 N MILLS AVE # 112
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-2812
Mailing Address - Country:US
Mailing Address - Phone:323-207-9012
Mailing Address - Fax:
Practice Address - Street 1:5050 PALO VERDE ST STE 128
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763-2334
Practice Address - Country:US
Practice Address - Phone:323-940-7749
Practice Address - Fax:323-389-9094
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-18
Last Update Date:2025-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA994821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical